POLICY ON VENOUS THROMBOEMBOLISM PROPHYLAXIS

An Evaluation of the Implementation of Policy on Venous Thromboembolism Prophylaxis

by

Acknowledgement

I would take this opportunity to thank my research supervisor? family and friends for their support and guidance without which this research would not have been possible.

DECLARATION

I? [type your full first names and surname here] ? declare that the contents of this dissertation/thesis represent my own unaided work? and that the dissertation/thesis has not previously been submitted for academic examination towards any qualification. Furthermore? it represents my own opinions and not necessarily those of the University.

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Abstract

Each year over 25?000 people in England die from venous thromboembolism (VTE) contracted in hospital. This is more than the combined total of deaths from breast cancer? Aids and traffic accidents? and more than 25 times the number who die from MRSA. Many of these deaths are preventable; there is a safe? efficacious and cost-effective method of preventing venous thrombosis which is not being as widely administered as it should be Health Select Committee.

Table of Contents

POLICY ON VENOUS THROMBOEMBOLISM PROPHYLAXIS1

ACKNOWLEDGEMENT2

DECLARATION3

ABSTRACT4

CHAPTER I: INTRODUCTION7

Introduction7

Aims8

Objectives8

Background And Rationale9

Study Design And Methods10

Analysis of Data10

Ethical Considerations11

CHAPTER II: LITERATURE REVIEW13

Literature Review13

Venous Thromboembolism15

Definitions15

Symptoms and Diagnosis of DVT and PE16

Burden of Disease16

Risk Factors18

Evidence-Based Guidelines or Recommendations for VTE Prevention19

At an individual level22

At an organisational level24

Implementation Of (VTE) Case Of NHS26

Setting27

Key Measures For Improvement31

Strategies For Change32

Educating and empowering patients32

Educating and empowering staff32

Introducing VTE checks into the “STOP” moment in theatre (World Health Organization? 2009)33

Introducing a competitive edge into VTE risk assessment34

Using individual patient stories to improve practice by feeding back to teams responsible for the primary hospital admission34

One size does fit all34

Effects Of Change35

Lessons Learned37

CHAPTER III: RESEARCH METHODOLOGY42

Research Methods42

Research Survey42

Participants42

Outcomes43

Types Of Studies43

Language Restriction44

Literature Search Strategies44

A Note On Referencing44

Methods Of The Review Literature Database45

Data Extraction45

Assessment Of Study Quality45

Expert Interdisciplinary Panel46

Inclusion Criteria46

Search Strategy47

Data Extraction And Analysis48

CHAPTER IV: RESULTS AND DISCUSSION49

Results And Discussion49

Survey Results49

Results from the English and Welsh NJR 1st Annual Report 201150

Results from The Scottish Arthroplasty Project Audit of Consultant Practice? 201051

Hip Replacement Thromboprophylaxis52

Knee Replacement Thromboprophylaxis53

CHAPTER V: CONCLUSION55

Conclusion55

REFERENCES56

CHAPTER I: INTRODUCTION

Introduction

It is well understood by the surgical professions that effective prescribing of chemoprophylaxis (the use of drugs to prevent a condition occurring) is vital to safe outcomes of patients undergoing total hip or knee replacement surgery due to the high risk group they fall into (Lassen et al? 2009? 1673-80). The response to the dangers of developing a deep vein thrombosis or a pulmonary embolism post-surgery involved numerous organisations at government level to produce clear evidence-based guidelines in order to prevent such an occurrence. These included the National Institute for Health and Clinical Excellence (NICE) and here the Department of Health (DoH) in England and Wales. NICE issued clinical guidelines for the prevention of venous thromboembolism as far back as 2007 [www.nice.org.uk/cg46]. After critical appraisal of these guidelines and a lack or under use of risk assessments evaluated (Maynard and Stein? 2009) ? further guidelines were produced by NICE [www.nice.org.uk/cg92] after a letter was sent to all NHS Trusts in England and Wales by the Department of ...